"Medication Matters"

Leslie A. DeLisle , APRN, PMHCNS-BC

"There is no health without mental health"

10 Signs Your Antidepressant Isn’t Working

For many people, finding the right depression treatment is a trial and error process. The STAR*D Report, the largest study looking at effectiveness of antidepressants, found that only 37 % of people experienced relief of symptoms after trying one medication, and 67 experienced remission after trying four.”

I mentioned that trial and error process, right?! Good news is that based on the symptoms we discuss in your visits, it often steers a provider toward the action of certain antidepressants (some are more activating, some are more calming, for example.

To improve your chances of finding the treatment that works best for you, look for these nine signs your antidepressant isn’t working, isn’t working well enough, or is no longer working like it should:

1. You feel better right away. This is actually a bad sign. Antidepressants work by increasing and balancing feel-good neurochemicals in your brain, including serotonin, dopamine, and norepinephrine, a process that takes some time. Depression relief from an antidepressant usually peaks at 6 to 8 weeks. If you experience an immediate improvement, it is either a medication side effect or placebo effect that will not maintain.

2. You skip doses,… often. This is a big barrier to effective treatment and can actually lead to rebound symptoms of mood instability or severe anxious distress.

3. You experience no relief from depression symptoms after a few months. In my opinion, you should see some improvement within two months of starting the medication. After this amount of time at an adequate dose, adequate dose being very important, likely best to switch to something else.

4. You feel a sudden surge of energy — along with the low mood. Antidepressants can cause problematic activation that may feel like an improvement from a depression that has stolen your energy for months to years, but when the low mood remains, this combination can lead to acting out or put you at increased risk for harm. It would be important to report these symptoms to your clinician right away.

5. You’re experiencing unpleasant side effects. They all have them, so when side effects happen, we switch to another! The good news is that there have been many advances in psychiatric medicine, so when we move through first line medications and evaluate effectiveness and tolerability in an evidence informed manner.

6. Your antidepressant doesn’t pack the punch it used to. If you have ever wondered if you can “become immune to your meds” or “they just stop working”, the answer is yes. The dosage may need to be increased or medication changed to enhance drug action.

7. Your depression gets deeper. This may be a sign that your antidepressant medication regimen may no longer be working. Specific warning signs to look out for include feeling hopeless, losing interest in things you used to find pleasurable, increased guilt, sadness, low energy or motivation, insomnia, agitation or restlessness, or feeling generally out of control.

8. Your depression symptoms have improved, but you’re still not yourself. If you experience some relief on an antidepressant, but it’s not the relief you hoped for, it may be time to try something new.

9. You’re having disruptive mood swings. At times, antidepressant medications can increase mood irritability or mood swings, especially in people who have been considered to have a bipolar spectrum illness. Symptoms to be watchful for are: feeling unusually elated, angry outburns, breaking things, bouts or rage, getting angry in the workplace or with family members that may be uncharacteristic for you.

10. After an extended period on an antidepressant, your depression is gone. After 9 to 12 months of complete remission of symptoms, it may be advisable to stop the antidepressant altogether. I cannot stress enough the importance of doing this in a specific way, prescribed by myself, to slowly taper off to decrease any discomfort to you and to decrease any chance of physical symptoms of withdrawal. Though not life threatening, they can be uncomfortable.


Considering psychotropic medications

I understand that it is often an anxiety producing experience to add another healthcare provider to your treatment team, and additionally difficult to tell your story to someone else. When considering that medications may be something you need, it is important to know that much evaluation and education goes into a pharmacotherapy appointment. Pharmacotherapy simply means, “medical treatment by means of drugs.” As an advanced practice nurse I believe strongly that there is no health without your mental health so we will talk openly about how your symptoms affect your day-to-day quality of living and how your physical health may or may not be impacted.

Psychotropic medications are used to treat severe and disabling mental health disorders. They treat disorders such as schizophrenia, bipolar disorder, depression, anxiety, and ADHD. These disorders often cause serious symptoms that interfere with daily activities and complicate interpersonal relationships. Unfortunately psychotropic medications do not cure these disorders, however they
can provide a significant amount of relief for disabling symptoms and they can help people live healthy and happy lives. There are many options available, though sometimes finding the right type of medication is often a trial and error process.

Making the decision to take psychotropic medication involves recognizing you have a serious issue that affects the overall quality of your life and interferes with your daily functioning. People come to the decision after careful consideration of all of their options. For example, consider what other treatments you have tried in the past and the symptoms you would like to treat. Research suggests that for certain issues a combination of medication along with therapy often leads to the best results for certain disorders. For other issues therapy may be the best option. Together, you and your therapist may have come to the decision together that a pharmacotherapy evaluation is an
important next step to offering you the best opportunity for progressing toward your goals. Again its important to discuss all of these options with your clinician and consider what you have tried in the past.
Medication can be useful. For example, for those with paralyzing anxiety, medication can "turn the volume down." For those unable to get out of bed in the morning because depression has stolen all motivation, medication can provide a "kick-start." And for those with a severe mental health condition that involves psychotic symptoms, medication can be a necessity for stability and/or
safety. Therefore, certain people may benefit from taking psychotropic medication, on a case-by-case basis.

Medication can support the therapy process. It is difficult for most people to focus on symptom relief and self-growth when they are in crisis or struggling with anxiety, depression, or other mental health conditions. In some cases, medication can help to stabilize a person, allowing him or her to progress in psychotherapy. For example, a study published in the Journal of the American Medical Association shows that cognitive behavioral therapy combined with targeted medication tends to
lead to significant improvement of attention deficit hyperactivity symptoms in adults. A common outcome of successful therapy is the reduction in the need for psychotropic medications.
(this is the link to the blue hyperlink above if readers could be linked to here… )
http://www.medicalnewstoday.com/articles/198809.php

Ultimately the decision to consider a medication will never be risk free, though you will be fully informed about any recommendations intended use, risks, benefits, and common and more serious side effects to be aware of. Together we can work toward making 2017 much better than you expected.

Leslie’s Corner - A blog that is updated every other month with evidence informed information worth sharing that will always have my own personal touches and style for your reading pleasure.

Prepared by Leslie A. DeLisle, APRN, PCNS-BC December 27, 2016

10 Signs Your Antidepressant Isn’t Working

For many people, finding the right depression treatment is a trial and error process. The STAR*D Report, the largest study looking at effectiveness of antidepressants, found that only 37 % of people experienced relief of symptoms after trying one medication, and 67 experienced remission after trying four.” I mentioned that trial and error process, right?! Good news is that based on the symptoms we discuss in your visits, it often steers a provider toward the action of certain antidepressants (some are more activating, some are more calming, for example.

To improve your chances of finding the treatment that works best for you, look for these nine signs your antidepressant isn’t working, isn’t working well enough, or is no longer working like it should:
1. You feel better right away. This is actually a bad sign. Antidepressants work by increasing and balancing feel-good neurochemicals in your brain, including serotonin, dopamine, and norepinephrine, a process that takes some time. Depression relief from an antidepressant usually peaks at 6 to 8 weeks. If you experience an immediate improvement, it is either a medication side effect or placebo effect that will not maintain.
2. You skip doses,… often. This is a big barrier to effective treatment and can actually lead to rebound symptoms of mood instability or severe anxious distress.
3. You experience no relief from depression symptoms after a few months. In my opinion, you should see some improvement within two months of starting the medication. After this amount of time at an adequate dose, adequate dose being very important, likely best to switch to something else.

4. You feel a sudden surge of energy — along with the low mood. Antidepressants can cause problematic activation that may feel like an improvement from a depression that has stolen your energy for months to years, but when the low mood remains, this combination can lead to acting out or put you at increased risk for harm. It would be important to report these symptoms to your
clinician right away.

5. You’re experiencing unpleasant side effects. They all have them, so when side effects happen, we switch to another! The good news is that there have been many advances in psychiatric medicine, so when we move through first line medications and evaluate effectiveness and
tolerability in an evidence informed manner.

6. Your antidepressant doesn’t pack the punch it used to. If you have ever wondered if you can “become immune to your meds” or “they just stop working”, the answer is yes. The dosage may need to be increased or medication changed to enhance drug action.
7. Your depression gets deeper. This may be a sign that your antidepressant medication regimen may no longer be working. Specific warning signs to look out for include feeling hopeless, losing interest in things you used to find pleasurable, increased guilt, sadness, low energy or motivation, insomnia, agitation or restlessness, or feeling generally out of control.
8. Your depression symptoms have improved, but you’re still not yourself. If you experience some relief on an antidepressant, but it’s not the relief you hoped for, it may be time to try something new.
9. You’re having disruptive mood swings. At times, antidepressant medications can increase mood irritability or mood swings, especially in people who have been considered to have a bipolar
spectrum illness. Symptoms to be watchful for are: feeling unusually elated, angry outburns, breaking things, bouts or rage, getting angry in the workplace or with family members that may be uncharacteristic for you.
10. After an extended period on an antidepressant, your depression is gone. After 9 to 12 months of complete remission of symptoms, it may be advisable to stop the antidepressant altogether. I cannot stress enough the importance of doing this in a specific way, prescribed by myself, to slowly taper off to decrease any discomfort to you and to decrease any chance of physical symptoms of withdrawal. Though not life threatening, they can be uncomfortable.
National Alliance on Mental Illness www.Nami.org
McPap for Moms

Massachusetts Child Psychiatry Access Project *For Moms - Resources and information for Women experiencing mental health issues during or after childbirth

https://www.mcpapformoms.org/Resources/SupportGroups.aspx
A resource for women who are breastfeeding including a link to information on medications and breastfeeding safety

http://kellymom.com/
An article that reviews commonly recommended medications from multiple classes that are first considered when medications are needed in breastfeeding women

http://www.aafp.org/afp/2001/0701/p119.html